The authors offer reflections and lessons learned in a single pediatric tertiary center’s experience during a pediatric mass casualty incident (MCI). The MCI occurred at a holiday parade and the patients were brought to multiple community emergency departments for initial resuscitation prior to transfer to the Pediatric level 1 trauma center. In total, 18 children presented with severe blunt force trauma after a motor vehicle entered the parade route. Following initial triage in emergency departments, 10 of 18 children injured during the incident were admitted to the Pediatric Intensive Care Unit, collectively representing a system-wide stressor of emergency medicine, critical care, and surgical services. Institutional characteristics, activation of personnel and supplies, and psychosocial support for families during an MCI are important to consider in children’s hospitals’ disaster preparedness planning.

We study the Cauchy problem on the real line for the nonlocal Fisher-KPP equation in one spatial dimension,

\begin{equation*} u_t = D u_{xx} + u(1-\phi *u), \end{equation*}

$\phi *u$

$\phi (y) \equiv H\left (\frac{1}{4}-y^2\right )$

$u=1$

$D$

$\Delta _1 \approx 0.00297$

$D \ll 1$

$O(1)$

$u=O(1)$

$u$

$D \to 0^+$

$D \geq \Delta _1$

$2 \sqrt{D}$

$0 \lt D \lt \Delta _1$

$u=0$

$D$

Background: Presenteeism when ill in healthcare personnel (HCP) can contribute to the spread of respiratory illness among HCP and patients. However, during the COVID-19 pandemic and now, there are substantial challenges preventing HCP from staying home when ill. We examined these challenges using the Systems Engineering Initiative for Patient Safety (SEIPS) framework. Method: As part of a larger anonymous electronic survey between 3/11/2022 and 4/12/2022 at an academic tertiary referral center, in inpatient and ambulatory settings where respondents were asked to describe factors impacting presenteeism when ill, we analyzed free-text responses using the SEIPS categories of tasks, tools/technology, person, organization, and physical environment. Result: 522 comments were received in response to the open-ended survey question asking individuals to describe any factors that would assist them in remaining home and/or help them get tested for COVID-19 when they have symptoms of a respiratory illness; 21 were excluded due to absent or incomplete response. Of the remaining responses (N = 501, Figure 1), 82% were associated with a single SEIPS component such as organization (N = 409), while other responses discussed factors that involved two SEIPS components, in no particular order (N = 92). A majority of the responses (N = 324, 55%) reported organizational barriers, frequently citing a strict sick call-in policy as well as a lack of protected time-off for COVID-19 testing or related absences. The next two most commonly identified components were physical environment (N= 88, 15%) and tasks (N = 72, 12%), mentioning barriers such as far distances to testing centers and prolonged waiting periods for testing Results: The person and tools/technology components were less commonly identified, with a frequency of 9% each. Conclusion: A number of systems level factors were identified that may impact the ability of HCP to stay home when ill. Interventions to help overcome HCP perceived barriers to staying home when experiencing respiratory symptoms should focus on the policies and practices within an organization. Communication from leadership should support staying home with respiratory symptoms by creating plans for coverage and back up consistently across all employee types in direct care.

The Classic Maya polities of Baking Pot and Lower Dover developed along two dramatically different trajectories. At Baking Pot, the capital and associated apical elite regime grew concomitantly with surrounding populations over a thousand-year period. The smaller polity of Lower Dover, in contrast, formed when a Late Classic political center was established by an emergent apical elite regime amidst several long-established intermediate elite-headed districts. The different trajectories through which these polities formed should have clear implications for residential size variability. We employ the Gini coefficient to measure variability in household volume to compare patterns of residential size differentiation between the two polities. The Gini coefficients, while similar, suggest greater differentiation in residential size at Baking Pot than at Lower Dover, likely related to the centralized control of labor by the ruling elite at Baking Pot. While the Gini coefficient is synonymous with measuring wealth inequalities, we suggest that in the Classic period Belize River Valley, residential size was more reflective of labor control.

The proposed model overlooks the self-referential and self-perpetuating nature of ownership intuitions. Human knowledge is primarily formed through social interaction within power dynamics. Accordingly, we suggest that legitimate ownership of one object can influence perceptions of legitimate ownership of another object. Ultimately, we argue that ownership intuitions are not independent but embedded in a self-referential system that perpetuates inequality.

We recently reported on the radio-frequency attenuation length of cold polar ice at Summit Station, Greenland, based on bi-static radar measurements of radio-frequency bedrock echo strengths taken during the summer of 2021. Those data also allow studies of (a) the relative contributions of coherent (such as discrete internal conducting layers with sub-centimeter transverse scale) vs incoherent (e.g. bulk volumetric) scattering, (b) the magnitude of internal layer reflection coefficients, (c) limits on signal propagation velocity asymmetries (‘birefringence’) and (d) limits on signal dispersion in-ice over a bandwidth of ~100 MHz. We find that (1) attenuation lengths approach 1 km in our band, (2) after averaging 10 000 echo triggers, reflected signals observable over the thermal floor (to depths of ~1500 m) are consistent with being entirely coherent, (3) internal layer reflectivities are ≈–60$\to$–70 dB, (4) birefringent effects for vertically propagating signals are smaller by an order of magnitude relative to South Pole and (5) within our experimental limits, glacial ice is non-dispersive over the frequency band relevant for neutrino detection experiments.

Background: Amid the COVID-19 pandemic, healthcare systems were stretched thin, with staffing shortages posing substantial challenges. Limiting spread of COVID-19 among healthcare professionals (HCP) is paramount to preventing exacerbation of such shortages, but strategies are highly dependent on HCP self-screening for symptoms and isolating when present. We examined HCP perceptions of barriers and factors that facilitate staying home when experiencing respiratory symptoms. Methods: At an academic tertiary-care referral center, in inpatient and ambulatory settings, we conducted an anonymous electronic survey between March 11, 2022, and April 12, 2022. Using logistic regression analysis, we analyzed predictors of employees reporting to work with respiratory symptoms using STATA and SAS software. Results: In total, 1,185 individuals including 829 clinical staff and 356 nonclinical staff responded to the survey. When excluding participants who reported working “remotely” (N = 381) and those who reported being unsure of whether they had worked with symptoms (N = 14), the prevalence of working with respiratory symptoms was 63%. There was no significant difference between clinical and nonclinical staff (OR, 1.1; 95% CI, 0.8–1.5; P = .60). Increasing number of years of service was protective against working with symptoms, achieving statistically significance in multivariable analysis after 16 years. Compared to those having worked <1 year, the odds ratios of working with symptoms were 0.32 (95% CI, 0.16–0.65; P = .002), 0.33 (95% CI, 0.15–0.74; P = .007), and 0.32 (95% CI, 0.13–0.79; P = .007) for those working 16–20 years, 21–25 years, and ≥26 years, respectively. More than half of HCP who worked with symptoms identified being understaffed (56.9%), having mild symptoms (55.3%), and sense of responsibility (55.1%) as reasons to work with respiratory symptoms. The following barriers, or reasons to work with symptoms, were more commonly identified as significant by those who worked with symptoms compared to those who did not: being understaffed (OR, 1.87; 95% CI, 1.35–2.58; P ≤ .001), having mild symptoms (OR, 1.96; 95% CI, 1.42–2.71; P < .001), and lack of support from management (OR, 1.84; 95% CI, 1.07–3.18; P = .03). Conclusions: Working with respiratory symptoms is prevalent in clinical and nonclinical HCP. Those with fewer years of work experience appear to be more susceptible to misconceptions and pressures to work despite respiratory symptoms. Messaging should stress support from leadership and the significance of even mild respiratory symptoms and should emphasize responsibility to patients and colleagues to stay home with respiratory symptoms. Strategies to ensure adequate staffing and sick leave may also be high yield.

Disclosures: None